Copyright © 2002 by the European Society of Cardiology.
Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction. Insights from TIMI 14 and InTIME-II
a Brigham and Women's Hospital, Boston, MA, U.S.A.
b Harvard Clinical Research Institute, Boston, MA, U.S.A.
c The Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas, Southwestern Medical Center, Dallas, TX, U.S.A.
d Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
e Eli Lilly, Inc, Indianapolis, IN, U.S.A.
f Centocor, Malvern, PA, U.S.A.
revised August 20, 2001; accepted August 22, 2001
Abstract
Background When evaluating new reperfusion regimens for ST elevation MI, it is important to adjust for factors that influence the likelihood of achieving normal epicardial flow and complete ST resolution.
Methods and Results A total of 610 patients from TIMI 14 contributed to the angiographic analyses. The electrocardiographic analyses were based on 544 patients from TIMI 14 and 763 patients from InTIME-II. For each hour from onset of symptoms to initiation of pharmacological reperfusion, the odds of achieving TIMI3 flow at 90min or complete ST resolution at 60–90min decreased significantly (P=0·03). Anterior location of infarction was associated with a reduction in the odds of achieving TIMI3 flow or complete ST resolution. The use of abciximab as part of the reperfusion regimen significantly increased the odds of TIMI3 flow (P=0·01) and ST resolution (P<0·001). The fibrinolytic administered (alteplase, reteplase, lanoteplase) did not influence the odds of TIMI3 flow or ST resolution after adjusting for time to treatment, infarct location, and use of abciximab.
Conclusions The influence of time from symptoms on epicardial flow and STRES reinforces the need for increased efforts to reduce treatment delays in patients with ST elevation MI. The significant benefits of abciximab with respect to facilitation of epicardial and myocardial reperfusion are evident even after adjusting for time to treatment and infarct location. To adjust for determinants of success of reperfusion regimens, phase II trials evaluating new drug combinations should consider using a randomization scheme that stratifies patients based on infarct location and time from symptoms.
Key Words: Thrombolysis, acute MI, glycoprotein IIb/IIIa inhibition, antiplatelet therapy
f1 Correspondence: Elliott M. Antman, M.D., Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, U.S.A.
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